Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA.
BACKGROUND & AIMS:
We aimed to characterize offers of organs to candidates awaiting liver transplantation (LT).
We analyzed data from the United Network for Organ Sharing registry on all US LT candidates with non-fulminant disease who were offered livers from February 1 2005 to January 31, 2010 and ultimately received transplants. We excluded candidates with a final model for end-stage liver disease (MELD) scores <15. Livers were classified as high quality if they were from donors 18-50 years of age who were ≥170 cm tall, of non-black race, suffered brain death secondary to trauma, hepatitis C antibody-negative, not categorized as high risk by the Centers for Disease Control, and locally or regionally located.
Of 33,389 candidates for LT, 20% died or were removed from the list and 64% were received LT; the median (interquartile range) number of liver offers for all candidates was 5 (range, 2-12). Of those who died or were removed from the list, 84% received ≥1 liver offer (s). Overall, 55% those who died or were removed from the list, and 57% of those who received LT, received ≥1 offer of a high-quality liver, when they had MELD scores ≥15 (P =.005). However, the proportion of last liver offers of high-quality to patients that underwent LT was twice that of patients that died or were removed from the list (28 vs 14%; P <0.001). Most liver offers (68%) were refused for reasons related to donor quality.
Most candidates for LT who died or were removed from the list received ≥1 offer of a liver beforehand, and 55% received ≥1 offer of a high-quality liver. These findings indicate that a substantial proportion of wait-list mortality results in part from declined, rather than lack of opportunity, for transplantation. Understanding the real-time factors involved in the complex decision to accept a liver offer is vital to reducing wait-list mortality for LT candidates.